comparison of regional splanchnic tissue oxygenation measured by nirs in preterm babies fed bolus versus continuous feeding

Conditions: Premature; Infant, Light-for-dates; Feeding Patterns

Summary: early initiation of enteral feeding, achievement of full enteral feeding and cessation of parenteral nutrition are extremely important in the very premature infant. this way it is possible to achieve good post-natal growth and developement while minimizing the metabolic and infectious complications of parenteral feeding. there isn't much information in literature regarding the impact of enteral feeding on intestinal blood flow and intestinal regional oxygenation in the preterm infant. there is also no consensus regarding the best regimen of delivering the enteral nutrition - bolus feeding or continuous feeding. the aim of our study is to compare the intestinal regional oxygenation before and after two feeding regimens - bolus feeding and continuous feeding - in clinically stable preterm infants born before 32 weeks gestation. the evaluations will be performed using nirs technology (near infrared spectroscopy). the study may help to assess which feeding regimen is gentler to the immature intestines (i.e. alters less the splanchnic blood flow and oxygenation) and therefore the preferred way to feed preterm infants.

early initiation of enteral feeding, achievement of full enteral feeding and cessation of parenteral nutrition are extremely important in the very premature infant. this way it is possible to achieve good post-natal growth and developement while minimizing the metabolic and infectious complications of parenteral feeding. there isn't much information in literature regarding the impact of enteral feeding on intestinal blood flow and intestinal regional oxygenation in the preterm infant. there is also no consensus regarding the best regimen of delivering the enteral nutrition - bolus feeding or continuous feeding. the aim of our study is to compare the intestinal regional oxygenation before and after two feeding regimens - bolus feeding and continuous feeding - in clinically stable preterm infants born before 32 weeks gestation. the evaluations will be performed using nirs technology (near infrared spectroscopy). the investigators intend to assess 20 clinically stable, appropriate for gestational age preterm infants, born before 32 weeks of gestation and receiving full enteral feedings at least 1 week prior to enrollment with no signs of feeding intolerance. all 20 participants evaluated constitute the 2 study groups: 1. group 1 = bolus feeding - before and after one bolus feeding 2. group 2 = continuous feeding - before and after one continuous feeding. the study may help to assess which feeding regimen is gentler to the immature intestines (i.e. alters less the splanchnic blood flow and oxygenation) and therefore the preferred way to feed preterm infants.

Eligibility criteria:
inclusion criteria: * born 23+0 to 31+6 weeks gestational age. * appropriate for gestational age. * clinically stable. * full enteral feeding at least 1 week prior to enrollment. * bolus feeding. * no signs of feeding intolerance. exclusion criteria: * major congenital anomalies (severe heart or cerebral disease, chromosomal abnormalities, any malformation or disease of the gastrointestinal tract). * previous diagnosis of necrotizing enterocolitis or spontaneous intestinal perforation. * need for blood transfusion 1 week prior to enrollment. * need for vasopressor therapy 1 week prior to enrollment. * cutaneous disease not allowing the placement of the nirs probe.

Keywords: near infrared spectroscopy bolus nutrition continuous nutrition mesenteric circulation